The Healthcare Commission today released its second annual health check of NHS organisations. The overall picture is a familiar one; things have got a bit better, but not by as much as one would have hoped. “Could do better” is the general feeling – not least in offering patients a choice.
Forty-six per cent of trusts were rated as either excellent or good on quality of services – a 5 percentage point improvement on last year. But only 37% were rated in these categories for use of resources; though admittedly a significant improvement on the 16% from last year. More worryingly however, a quarter of trusts were found wanting on basic hygiene standards, 33 trusts were rated weak on quality, of which twenty were also rated weak for use of resources. Most of these were in rural areas – ‘medical postcode lottery continues to create regional variations in the quality of services’.
But the Healthcare Commission also identified a clear pattern between standards of care in those trusts that have been subject to the most reorganisation and those that haven’t – among both hospitals and PCTs the ‘new’ performed the worst. This is wholly unsurprising, particularly given the complex commissioning environment that is now in operation. The Healthcare Commission quite rightly felt strongly enough about this to fire a clear warning shot at the ever-tinkering government: “[it] should think carefully about whether the benefits [of reorganisations] will in the short and medium term outweigh the costs”.
Unfortunately – as the recent interim report by Lord Darzi well indicates – it probably won’t listen. Short-termism and the itch to direct from the centre still reigns.
Indeed, perhaps the most significant finding (or rather re-emphasis) of the whole report, that sticks out like a sore thumb to anyone who supports the more market-based orientation set by Blair et al., is the sad irony that the NHS is performing by far the worst on the one target that really offers the long-term and self-sustaining drive for better performance: patient choice. Just 43% of patients even recalled being offered a choice of hospital for their outpatients’ appointment or operation, and a meagre 11% of PCTs offer this choice to 90% of its patients the ‘Choose and Book’ system. Combining the two, just 2% of PCTs met the target – 70% were miles off.
This is a fantastic failure; and one that PCTs must move to correct urgently if competition is going to have any chance of working and the NHS is to move beyond its patriarchal instincts to focus on the patient.